The distinction made in ' Duty to Treat: where do the limits lie? ' (BMJ 2020;369.m2150) between accepted overall positive duties of citizens to assist others and the supererogatory duty of individuals in specialized roles and occupations is compelling. However, it is difficult to define clearly enough so as to be acceptable as the basis of a duty to treat without limits or not.
Yes, the examples given clearly indicate where a fully trained individual (physician, firefighter, etc) would be expected to assist even with significant risk of self harm. The public understanding is that individuals in such occupations take upon themselves a degree of 'self sacrifice' beyond that expected of others. Long before (and hopefully beyond) Covid 19, physicians have undertaken personal risks across a wide spectrum to ensure provision of care to patients. Much of this risk is completely unknown to the public.
These risks include chronic sleep deprivation for years in training in intensive care, surgical, anaesthesia, emergency and other programs and subsequently as attending consultants. The litany of adverse consequences from falling asleep at the wheel while driving home to alcohol and drug abuse and marital breakdown among physicians has been well documented. Exposure to many contagious diseases, needle stick and other injuries, has always been a part of clinical practice. Working in certain specialties such as emergency or psychiatry a physician runs the risk of physical assault.
Traditionally physicians have accepted all of this personal risk as part of their fiduciary duty to place the welfare of patients above and beyond their own welfare. The acceptance of inadequate PPE for front line physicians (and other health care providers) in high risk Covid 19 settings seems to me to be a continuation of this traditional mindset. It is about time that physicians publicize all of the serious risks of being a 'good doctor' in addition to the excellent example provided relating to Covid 19 and PPE.
Competing interests:
No competing interests
08 June 2020
Paul Byrne
Physician
Grey Nuns Hospital, Edmonton, and John Dossetor Health Ethics Ctr, University of Alberta
Rapid Response:
Re: Duty to treat: where do the limits lie?
Dear Editor
The distinction made in ' Duty to Treat: where do the limits lie? ' (BMJ 2020;369.m2150) between accepted overall positive duties of citizens to assist others and the supererogatory duty of individuals in specialized roles and occupations is compelling. However, it is difficult to define clearly enough so as to be acceptable as the basis of a duty to treat without limits or not.
Yes, the examples given clearly indicate where a fully trained individual (physician, firefighter, etc) would be expected to assist even with significant risk of self harm. The public understanding is that individuals in such occupations take upon themselves a degree of 'self sacrifice' beyond that expected of others. Long before (and hopefully beyond) Covid 19, physicians have undertaken personal risks across a wide spectrum to ensure provision of care to patients. Much of this risk is completely unknown to the public.
These risks include chronic sleep deprivation for years in training in intensive care, surgical, anaesthesia, emergency and other programs and subsequently as attending consultants. The litany of adverse consequences from falling asleep at the wheel while driving home to alcohol and drug abuse and marital breakdown among physicians has been well documented. Exposure to many contagious diseases, needle stick and other injuries, has always been a part of clinical practice. Working in certain specialties such as emergency or psychiatry a physician runs the risk of physical assault.
Traditionally physicians have accepted all of this personal risk as part of their fiduciary duty to place the welfare of patients above and beyond their own welfare. The acceptance of inadequate PPE for front line physicians (and other health care providers) in high risk Covid 19 settings seems to me to be a continuation of this traditional mindset. It is about time that physicians publicize all of the serious risks of being a 'good doctor' in addition to the excellent example provided relating to Covid 19 and PPE.
Competing interests: No competing interests